The Institute of Medicine has identified interprofessional education (IPE) as a key innovation for achieving the triple aim of better care, better outcomes and reduced health care costs. Yet, a shortage of qualified faculty and difficulty with aligning learners' schedules often prevent sustainable and scalable IPE. Now, a team of New York University researchers from both the College of Nursing (CoN) and NYU School of Medicine (SoM), are addressing the barriers to wide-spread adoption of IPE.
Led by Maja Djukic, PhD, RN, assistant professor at the CoN, and Marc Triola, MD, associate professor of medicine at the SoM the researchers have designed a virtual IPE curriculum in which students were paired with a virtual team member to learn with, from, and about each other to improve collaboration and the delivery of care.
Their paper, "E-Learning with virtual teammates: A novel approach to interprofessional education," appeared in the Journal of Interprofessional Care, June 2015. It concluded that their virtual IPE is an effective and efficient learning tool, and may be of particular benefit to medical and nursing schools that do not have a partner school. All components of the virtual IPE intervention are available for implementation by other schools at no cost on NYU School of Medicine's Division of Educational Informatics website.
"Until the turn of the century, it was conventional for doctors, nurses, physician assistants, pharmacists and other healthcare professionals to be educated independently of one another," said Djukic. "The problem," explains Triola, "was that this model created a culture of fractured communication between medical professionals of different disciplines. Now we realize the whole is greater than the sum of its parts, provided the pieces fit together."
Prior to this study, little was known about the effectiveness of e-learning with virtual teammates for IPE.
NYU researchers hypothesized that there would be no difference in the learning outcomes for each intervention. To determine the efficacy of virtual IPE, the researchers administered virtual teammates to 540 students, and compared their outcomes with those of 220 students who had taken the traditional blended-learning curriculum a year prior.
In the blended-learning curriculum, participants partook in a one-time 4-hour in-person seminar and small-group learning session, and were paired with peers from the opposite school to complete the same seven e-modules as those in the virtual IPE cohort. The e-modules required learners from both disciplines to gain an understanding of cross-professional teamwork and collaboration perspectives by contributing comments.
To measure changes in their knowledge, students were given multiple-choice tests before and after the modules were administered. The researchers also gauged changes in students' teamwork ability and attitudes. They found that the support for their hypothesis varied according to the type of learner (i.e. medical or nursing) and the type of outcome (knowledge, skills, or attitudes).
For nursing students:
- The gains for the virtual learning cohort were significantly higher compared to the blended-learning cohort with regards to team members' roles and responsibilities, teams and team work, communication and conflict resolution, and interprofessional care planning.
- The outcomes in team skills and attitudinal domains were comparable across the two nursing cohorts, leading researchers to conclude that, for nursing students, the virtual IPE learning approach had no disadvantages over a blended-learning approach for their program.
For medical students:
- Outcomes in knowledge, team skills and team efficiency were comparable between the virtual and blended-learning cohorts.
- However, the virtual cohort showed greater improvement in shared leadership when compared to their peers in the blended-learning cohort, while for team value, the blended-learning cohort improved more.
- The researchers concluded that for their program, medical students who participated in the virtual IPE intervention reported similar changes in their team skills and attitudes as the students from the blended-learning cohort.
The findings of this study are largely consistent with existing knowledge on the efficacy of e-learning and virtual patients for a variety of clinical topics. The study adds to this evidence by demonstrating that a virtual learning approach is not less effective than a blended-learning approach for IPE. Furthermore, this study highlights an interesting phenomenon that authenticity and relevance of the educational topic may be more compelling to the learner than fidelity.
In this study, faculty crafted virtual teammates to represent optimal interprofessional partners who provided helpful and positive clinical notes and comments. These virtual mimics of actual teammates had no apparent detrimental effects on student outcomes and provided all benefits of a scalable and truly asynchronous e-learning intervention.
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Researcher Affiliations: Maja Djukic1, Jennifer Adams2, Terry Fulmer3, Demian Szyld4, Sabrina Lee5, So-Young Oh5 and Marc Triola2.
- 1. College of Nursing, New York University, New York, NY, USA.
2. School of Medicine, New York University, New York, NY, USA.
3. Bouve College of Health Sciences, Northeastern University, Boston, MA, USA.
4. New York Simulation Center, New York, NY, USA.
5. Division of Educational Informatics, New York University, New York, NY, USA.
Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the writing and contents of this paper. The Josiah Macy Jr. Foundation provided the funding for the project.
Acknowledgements: The researchers acknowledge the special contribution of the following individuals to the initial conceptualization and implementation of the NYU3T program: Farida Fatehi, M.S., assisted with statistical analyses and Meriel McCollum provided technical support for the preparation of the manuscript.
About New York University College of Nursing NYU College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science in Nursing, a Master of Science and Post-Master's Certificate Programs, a Doctor of Philosophy in Research Theory and Development, and a Doctor of Nursing Practice degree. For more information, visit https://nursing.nyu.edu/
About NYU School of Medicine NYU School of Medicine is one of the nation's preeminent academic institutions dedicated to achieving medical education excellence. For 170 years, NYU School of Medicine has trained thousands of physicians and scientists who have helped to shape the course of medical history and enrich the lives of countless people. An integral part of NYU Langone Medical Center, the School of Medicine at its core is committed to improving the human condition through medical education, scientific research and direct patient care. The School also maintains academic affiliations with area hospitals, including Bellevue Hospital, one of the nation's finest municipal hospitals where its students, residents and faculty provide clinical and emergency care to New York City's diverse population, which enhances the scope and quality of their medical education and training. NYU School of Medicine has earned national attention in recent years for reimagining medical education to address the needs of future physicians, recently announced it is #14 in the nation for research, and #2 in New York, out of 130 medical schools on the 2016 U.S. News & World Report's "Best Graduate Schools" rankings. Additional information about the NYU School of Medicine is available at http://school.med.nyu.edu/.
Journal
Journal of Interprofessional Care